本帖最后由 大尾巴甩甩 于 19-1-2014 17:43 编辑
谢谢星星,Kevin。 在HCF官网上看到，HCF是No Gap.
本来以为应该是会便宜吧, 但鬼佬们在这个帖子里讨论medibank or HCF http://forums.whirlpool.net.au/archive/2196558
说其实No Gap可能反而会更贵。
摘两段如下 大家看看
Beware of "No GAP" and "Known Gap"
I work in the healthcare field and unfortunately there is a VERY important aspect on choosing health insurance that few if any know about and the health funds certainly don't seem to want to talk about. Funds pay different amounts and thus your out of pocket costs will be very different between them.
"Known Gap Funds"
(Eg Medibank, , Australian Unity and most funds that are part of Australian Health Service Alliance (eg Defence Health, Teachers Health, Police Health, AHM, CUA etc).
These funds have “KNOWN GAP” schemes meaning they allow a “gap” when specialists charge a gap (which most do). With these funds, an account is sent directly to your private fund (who also claim from Medicare on your behalf) and you receive an account for the balance or ‘gap’ only.
No Gap" Funds
(eg HBA, BUPA, MBF, NRMA, NIB, HBF, HCF, Manchester Unity etc)
Despite the name "No gap", if a specialist charges a gap (again many if not most do) these funds have so called “No Gap” schemes that don’t allow a “Gap” account. When a gap is charged, they drop their rebate rate to the MBS fee (massive drop!) and thus you end up with high out of pocket expenses. They are trying to force the medical provider not to charge a gap by preying on his conscience that the patient will end up with a large out of pocket the minute the provider charges even $1 more than the fee the fund specifies he/she should charge.
"Budget" Funds
(eg GMHBA, Latrobe etc)
These funds allow a gap but always pay lower rates (e.g. about 20% more than the MBS fee). Thus while you might save a bit on your monthly premiums expect to pay a lot more when you are claiming.
Disclaimer: There are some exceptions with the No gap funds depending on the specialty the provider is part of. This is not insurance advice. you should consult your fund or adviser before making any decisions.
Personally the above should be a MUCH more important aspect on which fund you choose than whether they are no for profit or have pretty logos or whatever as this is the single most important thing that will dictate whether you will have a small or large out of pocket fees should you have an operation.
Is there a document explaining this for DUMMIES, which explains it in very easy to understand terms, so others can read it?
Unfortunately there isn't and both health funds and governments make no effort in making it any clearer.
Some more info:
Will I know what the out of pocket fees will be?
Yes, Most doctors will send you a letter of Informed Financial Consent before your surgery detailing how much the fees will be and they are usually fairly accurate. So you usually shouldn't end up with unexpectedly high fees. If you find the expected fees too high you simply choose not to go ahead with the surgery.
Why a gap? I already pay for Insurance.
Because Medicare and the health funds have barely increased the fees they pay to specialists over the last decade, ignoring the rapidly rising costs of healthcare, medical indemnity insurance, operating costs etc and thus more and more specialists are charging a gap to make up for it. The funds happily increase THEIR monthly premiums 6-10% every year but they certainly don't increase what they pay specialists anywhere near that. They barely increase with inflation.
Can you give an Example between "Known Gap" and "No Gap" Out of Pocket Fees?
(Disclaimer: numbers are fictional. This is for demonstration purposes only and not intended to be accurate. Exact amounts will vary greatly depending on surgical item numbers. This is not to constitute insurance advice. Seek professional advice)
Let's assume you have a surgery of some kind and the specialist doesn't charge a gap then the funds may pay as such:
Medicare MBS rebate: $221
Australian Unity: $379
Medibank: $365 (medicare still pays the first $221)
BUPA/HBA: $396 (medicare still pays the first $221)
Nib: $344 (medicare still pays the first $221)
HCF: $380 (medicare still pays the first $221)
As you can see there is bit of difference on how much each fund pays the specialist:
IF the specialist decides to charge a total of $450 for their invoice then the Out of pocket fees will be:
"Known Gap Funds"
Australian Unity: $71 ($450-$379)
Medibank: $85 (($450-$365)
"No Gap Funds"
BUPA/HBA: $229 ($450 – $221)
Nib: $229 ($450 – $221)
HCF: $229 ($450 – $221)
See the difference? "No Gap" funds usually don't allow a gap and you get penalised by having a lower rebate once a specialist charges a gap. Most people don't realise this and just assume that the specialist is greedy and that's why they have ended up with a large gap when realistically they only charged as little as $70 more than the fee the health fund was offering to pay yet the patient has ended up $229 worse off. The funds are trying to force the specialist into not charging a gap by saying the patient will be much worse off.
欢迎comment.
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发表于 19-1-2014 15:29:01
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发表于 19-1-2014 15:31:54
楼主
发表于 20-1-2014 09:06:53
没有，保证没有~~~~
